Influences of three nucleotide drugs on renal function of patients with chronic hepatitis B and intervention effect of telbivudine on renal function injury caused by adefovir dipivoxil

Objective To compare the effects of single application of telbivudine(LdT), entecavir(ETV)and adefovir dipivoxil(ADV)on renal function of patients with chronic hepatitis B(CHB)and to explore the influence of LdT on renal function injury caused by ADV. Methods Totally 309 CHB patients in our hospital were randomly divided into LdT group(n=70), ETV group(n=94)and ADV group(n=145). In addition, 69 CHB patients with mild renal injury caused by ADV in the same period were divided into ADV transferring to LdT group(n=33)and ADV transferring to ETV group(n=36)according to the follow-up treatment. The serum creatinine(SCr)and estimated GFR(eGFR)level were compared among the 5 groups at the time points of 0, 48, 96 and 144 weeks of treatment. At the time point of 144 weeks, the change rates of SCr and eGFR levels relative to baseline levels were compared among 5 groups. At the time point of 144 weeks, the changes of eGFR distribution against baseline were compared among 5 groups. Results At the time points of 0, - 48, 96, and 144 weeks, the level of SCr in the ADV to LdT group decreased significantly, and the level of eGFR increased significantly(P<0.05), but there was no significant change in the levels of SCr and eGFR in the ADV transferring to ETV group. At the time points of 0, 48, 96, 144 weeks, there were significant differences in levels of SCr and eGFR among ADV group, LdT group and ETV group(P<0.05). At the time point of 144 weeks, the change rates of SCr and eGFR in LdT group was the most significant, especially in the ADV to LdT group. At the time point of 144 weeks, there were significant differences in distribution of eGFR when compared with those of baseline in ADV group, LdT group and ETV group(P<0.05), and there was a significant difference between the ADV transferring to ETV group and the ADV transferring to LdT group(P<0.05). Conclusion Among the CHB patients treated with single application of ADV, LdT and ETV, LdT shows the best protective effect on renal function, ADV is the worst and ETV shows no significant effect on renal function. For patients with renal impairment caused by ADV, application of LdT as a subsequent treatment can significantly improve the levels of SCr and eGFR as well as renal function.